2015, as the wonderful Lord Bagg reminded us this morning, is the 800th anniversary of Magna Carta. The speech of the once melodious Melvyn is maturing into the voice of the English Establshmnt, in which later vowls are largely discardd, and each utternce is gaspd, as f’twere speakers last, though never is. Over those 800 years since the first Magna Carta, the Gods of ye mystries have placed the Charter firmly in the mythical sphere, and lodged it anywhere between the Ye Olde Scroll of Ye Commone Law, to a scrap of parchment that was binned shortly after it was penned. Somewhere in the middle ground it is seen, primarily, as the first declaration in English history that the King be subject to the same laws as his people, and that furthermore the laws must be both just, ordered and decided by one’s peers. It was a momentous change.
800 years later, and still in the land of Magna Carta, we find that the medical profession remains in pre-Charter relations to its ruling body, the General Medical Council. The GMC makes up it’s own rules of what constitutes good medical practice, as frequently amended, can decide on a whim who to investigate and on what grounds, works on a guilty until proved innocent basis, and has a perceived tendency to protect its own. It raises ‘fees’ through an arbitrary ‘tax’ on it’s ‘subjects’. Through its delight in the application of the question of ‘insight’, it can transform the innocent eccentric into the guilty miscreant. Its punishments, though it denies they are such, are draconian and destructive of livelihood, so much so that even the chill hand of a possible ‘investigation’ can be enough to turn a once sanguine doctor into a wreck. For more vulnerable doctors, the chill hand can become a dead hand, with over one and ten hundred doctors dying over the last decade while under GMC Fitness to Practice (FtP) procedures, the most serious level of investigation. Of those deaths, at least twenty eight are known to be suicides, with the real number almost certainly far greater. Were the police to have deaths on this scale while subjects were in custody, there would be a national outcry; yet the scale of the doctor deaths goes largely unreported, largely unnoticed.
Putting aside those doctors who for whatever reason like to feed the crocodile, there is widespread fear of, distrust in and hatred for the GMC among doctors. Of the many factors eroding morale among doctors, it is fair to say that the GMC and Lord of the Flies antics of its operatives are a major factor if not the major factor. The body set up to protect patients from bad doctors is itself causing carnage among doctor-patients. The body that is about to mandate a duty of candour on doctors is itself notably coy about its own activities. Even something as simple as releasing the number of doctors who had died under its watch was first delayed, and then – crassly – released on the Friday before Christmas week, a cheap PR stunt intended to bury bad news.
There are many fronts and levels on which the GMC can be questioned, even attacked. Now that we know more about the deaths while under FtP investigation, we might ask why is the GMC so careless of these deaths? The Council’s headline response – emotional resilience training for doctors – makes about as much sense as ordering toughness training for turkeys facing the Christmas process. On its website, the Council employs the Nuremberg defence, just doing our job, protecting patients – but a good number of the FtP deaths were among patients who, as it happened, were also doctors. Even if judged, by its primary aim, protecting patients, the GMC has profoundly serious questions to answer.
If Dr No had to summarise what he thought was the fundamental flaw in the GMC, he would say it has the wrong people in the wrong places. Its Chief Pongo, Niall Dickson, has a background that includes teaching, public relations, publishing, journalism (albeit some health, but health is not medicine) and even think-tanking, but no front-line clinical work. The Council’s key policy makers and operatives are mostly lawyers (albeit leavened by some crocodile feeding doctors), with the whole enterprise run on legalistic lines. The problem is that not only are most lawyers not nice people (bear in mind the profession of law is second only to that of CEO in providing a safe haven for psychopaths), but lawyers are singularly ill-equipped to deal with the kind of ‘wicked’, as opposed to ‘tame’, problems that confront medical regulators. A topical and profoundly poignant example is the inability of the GMC to manage the duality manifest by the doctor-patient in its clutches. Lawyers are programmed to be binary: guilty or innocent, for the prosecution or for the defence, doctor or patient; yet the object of their sinister interest is very often both doctor and patient at one and the same time. This challenge of this almost quantum like duality is way beyond the capabilities of classically trained binary lawyers (if you want to spook a GMC lawyer, ask him whether Schrödinger’s doctor is dead or alive; or, for a simpler spook, ask him to explain Heisenberg’s Uncertainty Principle). Craving absolute binary certainty, the lawyer blunders on regardless with, as we all now know, disastrous, even fatal, consequences.
Medium term, the state-appointed-at-arm’s-length GMC council needs to be replaced by a new council elected by and partly from (Dr No suggests 49% medical, 51% lay) the profession. Some will throw up their arms in horror at such blatant self-regulation, but, unless you are police-state minded, professional self-regulation is always the best regulation, so long as it operates transparently, and electoral turnout is adequate (historically it has been feeble, but given the stakes, it is not beyond the wit of doctors to pull their voting finger out). One might even say that it is a, if not the, defining characteristic of a mature profession that it can self-regulate itself safely, fairly and effectively.
Yes, and pigs might fly, but still Dr No feeds his pigs in the hope that one day they will fly. In the meantime, doctors need a Magna Carta Medicorum, a Charter to protect doctors against the excesses of the current GMC. The wording of parts of the original MC (particularly clause 20 onwards) are as good a starting point as any, with the GMC required, on pain of extinction, to deliver to every doctor who pays an Annual Retention Fee, a sealed copy of the MC Medicorum, binding its conduct to the principles and requirements contained therein, on further pain of extinction, should it fail so to do.